TY - JOUR
T1 - Success factors in high-effect, low-cost eHealth programs for patients with hypertension: a systematic review and meta-analysis
AU - Blok, Sebastiaan
AU - Linden, Eva L. van der
AU - Somsen, G. Aernout
AU - Tulevski, Igor I.
AU - Winter, Michiel M.
AU - Born, Bert-Jan H. van den
N1 - Publisher Copyright: © The European Society of Cardiology 2020.
PY - 2021/11
Y1 - 2021/11
N2 - Background: eHealth programs can lower blood pressure but also drive healthcare costs. This study aims to review the evidence on the effectiveness and costs of eHealth for hypertension and assess commonalities in programs with high effect and low additional cost. Results: Overall, the incremental decrease in systolic blood pressure using eHealth, compared to usual care, was 3.87 (95% confidence interval (CI) 2.98–4.77) mmHg at 6 months and 5.68 (95% CI 4.77–6.59) mmHg at 12 months’ follow-up. High intensity interventions were more effective, resulting in a 2.6 (95% CI 0.5–4.7) (at 6 months) and 3.3 (95% CI 1.4–5.1) (at 12 months) lower systolic blood pressure, but were also more costly, resulting in €170 (95% CI 56–284) higher costs at 6 months and €342 (95% CI 128–556) at 12 months. Programs that included a high volume of participants showed €203 (95% CI 99–307) less costs than those with a low volume at 6 months, and €525 (95% CI 299–751) at 12 months without showing a difference in systolic blood pressure. Studies that implemented eHealth as a partial replacement, rather than addition to usual care, were also less costly (€119 (95% CI –38–201 at 6 months) and €346 (95% CI 261–430 at 12 months)) without being less effective. Evidence on eHealth programs for hypertension is ambiguous, heterogeneity on effectiveness and costs is high (I2 = 56–98%). Conclusion: Effective eHealth with limited additional costs should focus on high intensity interventions, involve a large number of participants and use eHealth as a partial replacement for usual care.
AB - Background: eHealth programs can lower blood pressure but also drive healthcare costs. This study aims to review the evidence on the effectiveness and costs of eHealth for hypertension and assess commonalities in programs with high effect and low additional cost. Results: Overall, the incremental decrease in systolic blood pressure using eHealth, compared to usual care, was 3.87 (95% confidence interval (CI) 2.98–4.77) mmHg at 6 months and 5.68 (95% CI 4.77–6.59) mmHg at 12 months’ follow-up. High intensity interventions were more effective, resulting in a 2.6 (95% CI 0.5–4.7) (at 6 months) and 3.3 (95% CI 1.4–5.1) (at 12 months) lower systolic blood pressure, but were also more costly, resulting in €170 (95% CI 56–284) higher costs at 6 months and €342 (95% CI 128–556) at 12 months. Programs that included a high volume of participants showed €203 (95% CI 99–307) less costs than those with a low volume at 6 months, and €525 (95% CI 299–751) at 12 months without showing a difference in systolic blood pressure. Studies that implemented eHealth as a partial replacement, rather than addition to usual care, were also less costly (€119 (95% CI –38–201 at 6 months) and €346 (95% CI 261–430 at 12 months)) without being less effective. Evidence on eHealth programs for hypertension is ambiguous, heterogeneity on effectiveness and costs is high (I2 = 56–98%). Conclusion: Effective eHealth with limited additional costs should focus on high intensity interventions, involve a large number of participants and use eHealth as a partial replacement for usual care.
KW - Hypertension
KW - ambulatory blood pressure monitoring
KW - costs and costs analysis
KW - healthcare costs
KW - self-management
KW - telemedicine
UR - http://www.scopus.com/inward/record.url?scp=85090853489&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/2047487320957170
DO - https://doi.org/10.1177/2047487320957170
M3 - Review article
C2 - 32915673
SN - 2047-4873
VL - 28
SP - 1579
EP - 1587
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 14
ER -